Earwax and Level of Paralysis

Short Communication

Earwax and level of paralysis

JH Frisbie*,1 and EH Zahn2 1,2Spinal Cord Injury and 1Medical Services, Department of Veterans Aﬀairs Medical Center, West Roxbury, MA, USA; Harvard Medical School, Boston, MA, USA

Study design: Inception cohort. Objectives: The clinical impression that earwax is uncommonly frequent among spinal cord injury patients with high levels ofparalysis was tested. Setting: Veterans Administration Hospital, USA. Methods: A cohort of15 chronically paralyzed patients, motor complete, living as residents in a long-term care facility was oﬀered monthly irrigations of the ears for removal of wax over a 6- month period. The number ofrequests was tabulated. All ears were examined once on a single day to determine point prevalence. The accumulated wax graded as absent or small, moderate or large. Results: Two patients with C2 lesions, aged 37 and 52 years and paralyzed 15 and 16 years, were compared with 13 patients at C4–T6 aged 44–78 years, median 62 years, and paralyzed 2– 33 years, median 24 years. Over a 6-month observation period, 10 irrigations were requested by the C2 patients and three by the C4–T6 patients. The reasons were hearing loss. Wax was found and removed, and symptoms were relieved in all instances, Po0.001. The spot survey revealed earwax ofmoderate or large amounts in four of four C2 patient ears and in two of 24 C4–T6 patient ears, P ¼ 0.001. Conclusion: Patients with C2 tetraplegia accumulate more earwax and request its removal more often than patients with lower levels of paralysis. Spinal Cord (2003) 41, 247–248. doi:10.1038/sj.sc.3101444 Keywords: spinal cord injury; earwax; cerumen; sebum; tetraplegia; quadriplegia

Introduction Earwax is an occasional problem for the able-bodied, a ofmonthly irrigations requested by the patients in each greater problem for the elderly and individuals with group was recorded. mental retardation,1,2 and, it appears, for certain After the 6-month survey, the patients were examined individuals with spinal cord injury (SCI). The following for earwax on a single occasion just prior to the next is an experience with resident in-house SCI patients. scheduled monthly irrigation. The accumulation ofwax was graded as 1 for absent or small amounts and as 2 for Methods moderate to large (occluding) amounts. The prevalences ofGrades 1 and 2 were tabulated forGroups A and B. During a tour ofduty at a long-term health-care facility Groups A and B were compared for the number of for spinal cord injured patients, monthly irrigations of requested treatments ofearwax by w2 analysis. The the ears for wax control were oﬀered to all patients. groups were also compared for the prevalence of earwax There were 15 patients, all with motor complete by the Fisher exact test. The software Primer of paralysis. These were divided, in retrospect, into Groups Biostatistics was used for all calculations.3 A and B. Group A consisted oftwo patients with C2 lesions, 37 and 52 years ofage, and paralyzed 15 and 16 years. Group B consisted of13 patients with lesions at Results C4–T6, median C6, aged 44–78 years, median 62 years, and paralyzed 2–33 years, median 24 years. The number The patients requesting irrigations did so with the complaint ofhearing loss usually and discomfort *Correspondence: JH Frisbie, Spinal Cord Injury Service, Department occasionally. Otoscopic exam revealed earwax in all ofVeterans Aﬀairs Medical Center, 1400 Veterans ofForeign Wars such instances. The amount ofwax removed varied from Parkway, West Roxbury, MA 02492, USA voluminous casts ofthe ear canal to small chips. A few Earwax and paralysis JH Frisbie and EH Zahn 248

Table 1 Frequency ofearwax removal in spinal cord injury patients by level ofparalysis a

Level of paralysis Number of patients Months without irrigation Months with irrigation Months total

C2 2 2 10 12 C4–T6 13 75 3 78

w2=53, Po0.001 aWe have encountered another C2, motor complete, patient as an outpatient. He has independently been requesting monthly irrigation ofhis ears

cases ofearwax were inspissated. Group A patients Conclusion required removal ofearwax considerably more fre- Regardless ofexplanation, it can be concluded that quently than Group B, see Table 1. The prevalence for Grade 2 earwax accumulation was four of four ears in earwax, a frequent cause of hearing loss, is a common complication ofhigh tetraplegia, motor complete. Group A and two of24 ears examined in Group B (one ofthe Group B patients had died), P ¼ 0.001.

Discussion References The greater earwax accumulation in the C2 patients 1 Roeser RJ, Ballachanda BB. Physiology, pathophysiology, could not be correlated with older age or greater and anthropology/epidemiology ofhuman ear canal secre- duration ofparalysis. But dysreflexia, although not tions. J Am Acad Audiol 1997; 8: 391–400. quantified in this cohort, was conceivably a factor. 2 Petrakis NL, Wiesenfeld SL, Flander L. Possible influence Sweating ofthe faceis a component ofthe dysreflexic ofage on the expression ofthe heterozygous cerumen reaction4 that occurs frequently – daily or several times phenotype. Am J Phys Anthropol 1986; 69: 437–470. a day – in some individuals with SCI. The sebaceous and 3 Glantz SA. Primer of Biostatistics. 4th edn. McGraw-Hill: the modified sudoriferous glands of the ear canals that New York, NY 1997. 4 Head H, Riddoch G. The autonomic bladder, excessive together produce cerumen and are responsive to 5 sweating and some other reflex conditions in gross injuries noradrenaline may participate, it is suggested, in ofthe spinal cord. Brain 1917; 40: 188–263. dysreflexic sweating. Alternately, facial blood flow, 5 Bende M. Human ceruminous gland innervation. J Laryngol and conceivably wax production, may be increased with Otol 1981; 95: 11–15. the patient lying supine because ofthe impaired defense 6 Silver JR. Circulatory reflexes in spinal man. Paraplegia ofthe circulation against gravity. 6,7 Serial comparisons 1965; 2: 235–246. between severity ofparalysis and position, facialblood 7 Mathias CJ, et al. Plasma catecholamines, plasma renin flow, blood pressure, sweating, and cerumen accumula- activity and plasma aldosterone in tetraplegic man, hor- tion would be required to test these suggestions. izontal and tilted. Clin Sci Mol Med 1975; 49: 291–299. On a therapeutic note, the flushing out ofearwax with 8 Andaz C, Whittet HB. An in vitro study to determine efficacy ofdifferent wax-dispersing agents. J Otol Rhinol water after treatment with heavy mineral oil overnight Laryngol 1993; 55: 97–99. was generally effective. Interestingly, water has been shown to disperse wax better than a variety of commercial oils in vitro.8

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